Comment

What is a hospital receptionist’s duty of care?

Following a Supreme Court ruling, emergency department clerical staff may require closer relationships with clinical teams

Following a Supreme Court ruling, emergency department clerical staff may require closer relationships with clinical teams

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Picture: iStock

In 2010, 26-year-old Michael Darnley was the victim of an assault. He sustained a head injury and was taken by a friend to the emergency department (ED) at Mayday Hospital, Croydon.

When Mr Darnley arrived at the reception desk and booked in, the receptionist advised him he would have to wait about 4-5 hours.

Mr Darnley felt unwell, decided not to wait in the waiting room and went home. He did not wait to see the assessing clinician.

His decision not to wait was based on allegedly misleading advice provided by the receptionist.

A short time later, Mr Darnley collapsed at home and an ambulance was called. On his return to the ED his level of consciousness was reduced and his GCS score was 9 out of 15.

A large extradural haematoma was identified. Mr Darnley underwent neurosurgical intervention, but was left with permanent brain injury and a left hemiplegia.

Breach of duty

In 2015, proceedings were brought against the Croydon Health Services NHS Trust, alleging a breach of duty on the part of the receptionist for giving incorrect and misleading advice on the waiting time.

The High Court Judge determined that the harm to Mr Darley was outside the scope of any duty of care or obligation owed by the receptionists.

In addition, it was considered that, as Mr Darnley had chosen to not wait in the ED, a causal connection had been broken. The claim of negligence against the trust was rejected.  

An appeal was made to the Supreme Court in June 2018 and, on 10 October, five Supreme Court justices overturned the earlier judgement.

It was judged that Mr Darnley’s decision to leave the ED was foreseeable and was based on misleading information from the receptionist about the waiting time to see a clinician, and so there was no break in the chain of causation.

The trial judge stated: ‘The provision of such misleading information by a receptionist as to the time within which medical assistance might be available was negligent.’

Colossal pressure

Supreme Court Justice Lord Lloyd-Jones acknowledged that EDs operate in difficult circumstances and under colossal pressure. However, he concluded that ‘it is not unreasonable to require receptionists to take reasonable care not to provide misleading information as to the likely availability of medical assistance. The provision of misleading information was negligent.’         

This is believed to be the first case of negligence involving ED receptionists giving misleading information. 

It is not uncommon in many EDs and minor injury units for patients to self-present, see a full waiting room or see the moving message board displaying the approximate waiting time and elect to leave.

Likewise, it is not uncommon for patients to ‘book-in’ and then decide not to wait, many of these might leave prior to contact with a clinician.

Traditionally, these patients are recorded as ‘did not wait’. It has usually been considered that these patients are responsible for their own decisions.  

Layer of responsibility

The ruling in Mr Darnley’s case will understandably cause concern among NHS managers and lead clinicians in emergency care. It will also cause an amount of anxiety with clerical and administration staff, who are always the first point of contact.

Mr Darnley’s solicitor has stated that ‘despite fears expressed by hospital trusts, this will not lead to a new layer of responsibility for clerical staff or a new layer of liability for the NHS.

‘The reception area of an emergency department is the first point of contact between the public and the hospital. The decision does not mean that reception staff should accurately state the precise time a patient would be seen by medically qualified staff. They must take reasonable care not to provide misleading information about the availability of assistance.

‘The standard of care required is that of an averagely competent and well-informed person performing the function of a receptionist in a department providing emergency medical care.’

Outstanding job

Receptionists in EDs and minor injury units do an outstanding job in sometimes challenging circumstances. They supervise the waiting room and keep clinicians informed and updated.

Following this ruling, it would be reasonable to expect reception staff to have a closer relationship with clinical teams. When waiting times become excessive clinicians need to be mindful of supporting them.

Waiting times should not be used as a subtle deterrent to encourage patients to go elsewhere, certainly not without contact with a healthcare professional.     

Further information

  • Darnley (Appellant) v Croydon Health Services NHS Trust (Respondent) On appeal from [2017] EWCA Civ 151

About the author

Mike_PaynterMike Paynter is a consultant nurse at Somerset Partnership NHS Foundation Trust and a member of the Emergency Nurse editorial advisory board

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